Exome Sequencing for Isolated Congenital Hearing Loss: A Cost-Effectiveness Analysis

Abstract

Objectives/hypothesis: To assess the relative cost-effectiveness of exome sequencing for isolated congenital deafness compared with standard care.

Study design: Incremental cost-effectiveness and cost-benefit analyses were undertaken from the perspective of the Australian healthcare system using an 18-year time horizon.

Methods: A decision tree was used to model the costs and outcomes associated with exome sequencing and standard care for infants presenting with isolated congenital deafness.

Results: Exome sequencing resulted in an incremental cost of AU$1,000 per child and an additional 30 diagnoses per 100 children tested. The incremental cost-effectiveness ratio was AU$3,333 per additional diagnosis. The mean societal willingness to pay for exome sequencing was estimated at AU$4,600 per child tested relative to standard care, resulting in a positive net benefit of AU$3,600. Deterministic and probabilistic sensitivity analyses confirmed the cost-effectiveness of exome sequencing.

Conclusions: Our findings demonstrate the cost-effectiveness of exome sequencing in congenital hearing loss, through increased diagnostic rate and consequent improved process of care by reducing or ceasing diagnostic investigation or facilitating targeted further investigation. We recommend equitable funding for exome sequencing in infants presenting with isolated congenital hearing loss.

Level of evidence: N/A. Laryngoscope, 131:E2371-E2377, 2021.

Keywords: Hearing loss; cost-effectiveness; deafness; economic evaluation; genetics; genomics.